Building a Semantic Model to Enhance the User's Perceived Functionality of the EHR.

In order to facilitate and increase the usability of Electronic Health Records (EHRs) for healthcare professional's daily work, we have designed a system that enables functional and flexible EHR access, based on the execution of clinical workflows and the composition of Semantic Web Services (SWS). The backbone of this system is based on an ontology. In this paper we present the strategy that we have followed for its design, and an overview of the resulting model. The designed ontology enables to model patient-centred clinical EHR workflows, the involved sequence of tasks and its associated functionality and managed clinical data. This semantic model constitutes also the main pillar for enabling dynamic service selection in our system.

Requirements for Workflow-Based EHR Systems - Results of a Qualitative Study.

BACKGROUND: Today's high quality healthcare delivery strongly relies on efficient electronic health records (EHR). These EHR systems or in general healthcare IT-systems are usually developed in a static manner according to a given workflow. Hence, they are not flexible enough to enable access to EHR data and to execute individual actions within a consultation. OBJECTIVES: This paper reports on requirements pointed by experts in the domain of diabetes mellitus to design a system for supporting dynamic workflows to serve personalization within a medical activity. METHODS: Requirements were collected by means of expert interviews. These interviews completed a conducted triangulation approach, aimed to gather requirements for workflow-based EHR interactions. The data from the interviews was analyzed through a qualitative approach resulting in a set of requirements enhancing EHR functionality from the user's perspective. RESULTS: Requirements were classified according to four different categorizations: (1) process-related requirements, (2) information needs, (3) required functions, (4) non-functional requirements. CONCLUSION: Workflow related requirements were identified which should be considered when developing and deploying EHR systems.

Formalizing the Austrian Procedure Catalogue: A 4-step methodological analysis approach.

OBJECTIVES: Due to the lack of an internationally accepted and adopted standard for coding health interventions, Austria has established its own country-specific procedure classification system - the Austrian Procedure Catalogue (APC). Even though the APC is an elaborate coding standard for medical procedures, it has shortcomings that limit its usability. In order to enhance usability and usefulness, especially for research purposes and e-health applications, we developed an ontologized version of the APC. In this paper we present a novel four-step approach for the ontology engineering process, which enables accurate extraction of relevant concepts for medical ontologies from written text. METHODS: The proposed approach for formalizing the APC consists of the following four steps: (1) comparative pre-analysis, (2) definition analysis, (3) typological analysis, and (4) ontology implementation. The first step contained a comparison of the APC to other well-established or elaborate health intervention coding systems in order to identify strengths and weaknesses of the APC. In the second step, a list of definitions of medical terminology used in the APC was obtained. This list of definitions was used as input for Step 3, in which we identified the most important concepts to describe medical procedures using the qualitative typological analysis approach. The definition analysis as well as the typological analysis are well-known and effective methods used in social sciences, but not commonly employed in the computer science or ontology engineering domain. Finally, this list of concepts was used in Step 4 to formalize the APC. RESULTS: The pre-analysis highlighted the major shortcomings of the APC, such as the lack of formal definition, leading to implicitly available, but not directly accessible information (hidden data), or the poor procedural type classification. After performing the definition and subsequent typological analyses, we were able to identify the following main characteristics of health interventions: (1) Procedural type, (2) Anatomical site, (3) Medical device, (4) Pathology, (5) Access, (6) Body system, (7) Population, (8) Aim, (9) Discipline, (10) Technique, and (11) Body Function. These main characteristics were taken as input of classes for the formalization of the APC. We were also able to identify relevant relations between classes. CONCLUSIONS: The proposed four-step approach for formalizing the APC provides a novel, systematically developed, strong framework to semantically enrich procedure classifications. Although this methodology was designed to address the particularities of the APC, the included methods are based on generic analysis tasks, and therefore can be re-used to provide a systematic representation of other procedure catalogs or classification systems and hence contribute towards a universal alignment of such representations, if desired.

A software tool to analyze clinical workflows from direct observations.

Observational data of clinical processes need to be managed in a convenient way, so that process information is reliable, valid and viable for further analysis. However, existing tools for allocating observations fail in systematic data collection of specific workflow recordings. We present a software tool which was developed to facilitate the analysis of clinical process observations. The tool was successfully used in the project OntoHealth, to build, store and analyze observations of diabetes routine consultations.

User needs and requirements analysis for big data healthcare applications.

The realization of big data applications that allow improving the quality and efficiency of healthcare care delivery is challenging. In order to take advantage of the promising opportunities of big data technologies, a clear understanding of user needs and requirements of the various stakeholders of healthcare, such as patients, clinicians and physicians, healthcare provider, payors, pharmaceutical industry, medical product suppliers and government, is needed. Our study is based on internet, literature and market study research as well as on semi-structured interviews with major stakeholder groups of healthcare delivery settings. The analysis shows that big data technologies could be used to align the opposing user needs of improved quality with improved efficiency of care. However, this requires the integrated view of various heterogeneous data sources, legal frameworks for data sharing and incentives that foster collaboration.

Designing an architecture for monitoring patients at home: ontologies and web services for clinical and technical management integration.

This paper presents the design and implementation of an architecture based on the combination of ontologies, rules, web services, and the autonomic computing paradigm to manage data in home-based telemonitoring scenarios. The architecture includes two layers: 1) a conceptual layer and 2) a data and communication layer. On the one hand, the conceptual layer based on ontologies is proposed to unify the management procedure and integrate incoming data from all the sources involved in the telemonitoring process. On the other hand, the data and communication layer based on REST web service (WS) technologies is proposed to provide practical backup to the use of the ontology, to provide a real implementation of the tasks it describes and thus to provide a means of exchanging data (support communication tasks). A case study regarding chronic obstructive pulmonary disease data management is presented in order to evaluate the efficiency of the architecture. This proposed ontology-based solution defines a flexible and scalable architecture in order to address main challenges presented in home-based telemonitoring scenarios and thus provide a means to integrate, unify, and transfer data supporting both clinical and technical management tasks.

An SNMP-based solution to enable remote ISO/IEEE 11073 technical management.

This paper presents the design and implementation of an architecture based on the integration of simple network management protocol version 3 (SNMPv3) and the standard ISO/IEEE 11073 (X73) to manage technical information in home-based telemonitoring scenarios. This architecture includes the development of an SNMPv3-proxyX73 agent which comprises a management information base (MIB) module adapted to X73. In the proposed scenario, medical devices (MDs) send information to a concentrator device [designated as compute engine (CE)] using the X73 standard. This information together with extra information collected in the CE is stored in the developed MIB. Finally, the information collected is available for remote access via SNMP connection. Moreover, alarms and events can be configured by an external manager in order to provide warnings of irregularities in the MDs' technical performance evaluation. This proposed SNMPv3 agent provides a solution to integrate and unify technical device management in home-based telemonitoring scenarios fully adapted to X73.